Background: An en bloc portal/superior mesenteric vein resection has become routine in high volume hospitals for locally advanced pancreatic head adenocarcinoma (PHA). However, it’s impact on survival still remain controversial. Aim: We investigated the impact on local/distant recurrence rate and on patients survival of an Intraoperative Ultrasound (IU) guided conservative approach inIshikawa type B neoplasia, in which we separate it from the vein, without performing primary en bloc vascular resection (VR). Patients & methods: Retrospective data of a consecutive duodeno-pancreatectomy (DP) for PHA, performed between 2008 and 2016, were reviewed. We selected a group of Ishikawa type Bin which, after checking the feasibility with IU, we preserved the vein without macroscopic residual (no vascular resection, nvrDP). We compared it with a Ishikawa type A standard DP (sDP). Results: 34 cases were nvrDP whereas 82 caseswere sDP. We didn’t find any statistically differences between the nvrDP group versus sDP group in term of isolated local recurrence rateat the time of diagnosis disease recurrence (12.5% vs18.9%), of systemic progression (38.5% vs 44.3%) or local plus synchronous systemic disease rate (4.9% vs 11.5%).There were no differences in terms of overall survival rate (1-year: 61% sDPvs 53% nvrDP; 3-year: 22% vs 18%; 5-years: 14% vs 17%; p=0.9). Conclusion: PD without VR could be considered safe and oncologically acceptable in the vast majority of Ishikawa type B PHA, without any significant influence on oncologic outcomes and “principled” vascular resection could not be justified in all the Ishikawa B PHA
ISHIKAWA TYPE B ADENOCARCINOMA OF THE PANCREATIC HEAD: DUODENO-PANCREATECTOMY WITHOUT VASCULAR RESECTION AN ONCOLOGICALLY ACCEPTABLE OPTION?
MORELLI, LUCA;GUADAGNI, SIMONE;FRANCO G, Di;PALMERI, MATTEO;FURBETTA, NICCOLO';FUNEL, NICCOLA;GAMBACCINI, DARIO;GIANARDI, DESIRÉE;BIANCHINI, MATTEO;MARCHI, SANTINO;CANDIO G, Di;MOSCA, FRANCO
2017-01-01
Abstract
Background: An en bloc portal/superior mesenteric vein resection has become routine in high volume hospitals for locally advanced pancreatic head adenocarcinoma (PHA). However, it’s impact on survival still remain controversial. Aim: We investigated the impact on local/distant recurrence rate and on patients survival of an Intraoperative Ultrasound (IU) guided conservative approach inIshikawa type B neoplasia, in which we separate it from the vein, without performing primary en bloc vascular resection (VR). Patients & methods: Retrospective data of a consecutive duodeno-pancreatectomy (DP) for PHA, performed between 2008 and 2016, were reviewed. We selected a group of Ishikawa type Bin which, after checking the feasibility with IU, we preserved the vein without macroscopic residual (no vascular resection, nvrDP). We compared it with a Ishikawa type A standard DP (sDP). Results: 34 cases were nvrDP whereas 82 caseswere sDP. We didn’t find any statistically differences between the nvrDP group versus sDP group in term of isolated local recurrence rateat the time of diagnosis disease recurrence (12.5% vs18.9%), of systemic progression (38.5% vs 44.3%) or local plus synchronous systemic disease rate (4.9% vs 11.5%).There were no differences in terms of overall survival rate (1-year: 61% sDPvs 53% nvrDP; 3-year: 22% vs 18%; 5-years: 14% vs 17%; p=0.9). Conclusion: PD without VR could be considered safe and oncologically acceptable in the vast majority of Ishikawa type B PHA, without any significant influence on oncologic outcomes and “principled” vascular resection could not be justified in all the Ishikawa B PHAI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.